That’s the discouraging number cited by the Cheshire County HEAL coalition in a recent report on its partnership initiative with local communities to address the challenge of obesity. HEAL, which stands for Healthy Eating, Active Living, is starting to make progress, but Terry Johnson, who directs the statewide effort, concedes that it will be a long battle.

“We’ve been focusing on fighting obesity since 2008,” says Johnson, who is based in Concord. “We’re looking at strategies to improve access to affordable foods, working on obesity prevention in schools. This is a long-term project.”

One of the Cheshire County HEAL initiatives that’s starting to take off is a program called Turn a New Leaf. It’s an effort to encourage restaurants, cafeterias at large businesses, and others who provide food to the public to develop healthy dining options.

“Fifty percent of our food dollars are spent outside the home,” says Maryanne Keating, program coordinator for Cheshire County HEAL. “It’s difficult for consumers to choose the healthiest options. We’re trying to make the healthy choice an easy choice.”

Keating says the Turn a New Leaf program started a couple of years ago at four pilot sites in Keene — the Center Court cafe at Cheshire Medical Center, the Community Kitchen, the Port Authority Cafe and Luca’s Mediterranean Cafe. It has now expanded to other sites, including the Keene Swamp Bats concession stands and the Home Healthcare, Hospice and Community Services friendly meals served in area towns.

“We ask them to show us their recipes for evaluation,” Keating says. “We have dietetic interns at Keene State analyze the options. We give back suggestions and the restaurants implement them on their menus.”

Keating says it’s a win-win situation, because the program does more than develop healthy options. It also give the Keene State students valuable experience related to their future profession.

Once a menu item is revised, it is evaluated, based on criteria that call for emphasizing fruits, vegetables and whole grains, limiting calories and saturated fats, and eliminating trans fats.

“Depending on the results, a menu item will qualify for one, two or three hearts,” Keating says. “Patrons will see those hearts on the menu, which will tell them it’s a healthy item.”

Luca Paris, owner and chef at Luca’s Mediterranean Cafe, praised Turn a New Leaf in a brochure HEAL is using to promote the program to other businesses.

“As a small entrepreneur, I do not have the resources the larger chain restaurants have to do a nutritional analysis and market the healthier menu choices that customers are looking for,” Paris said. “This program enhances what we do by taking some of our proven recipes and giving it a third-party healthy stamp of approval.”

Keating says HEAL is working to bring the program to schools, nursing homes and other food venues throughout the county.

Cheshire County HEAL is also sponsoring worksite wellness programs at six businesses in the Keene area and a pilot after-school program on gardening and nutrition for children, run through the Keene Rec Department. Johnson says the county programs are models that could be expanded on a state level.

As for results, Johnson says there isn’t a lot of data in so far, although one of the programs run by the Department of Health and Human Services for families enrolled in an infants and children’s program shows a slight reduction in obesity.

“We’re looking at decades to turn this around,” Johnson says of the fight against fat. “We’re in it for the long haul.”

That’s also the approach to obesity being taken by the ConVal School District’s food service program. Last year, Food Service Director Donna Reynolds and her staff made a number of changes to their school lunch offerings, in response to new federal guidelines, even as the guidelines themselves — which had set maximum levels of calories for lunch servings — were loosened partway through the year after nationwide complaints from students and parents

“This year, it’s breakfast’s turn,” Reynolds says. “Breakfasts for kids in grades K through 5 have to be at least 350 calories and no more than 500. So those are the guidelines for our elementary and middle schools. We’re serving more whole-grain items. We’re offering a 4-ounce juice along with a half cup of fruit, or they can take two fruit servings.”

The district is also offering what’s called a “Grab n’Grow” breakfast at the elementary schools at either breakfast or snack time. The bags contain two servings of grain and/or protein, one serving of fruit, one serving of juice and a milk.”

“We used to offer juice or a fruit serving. Now we have both,” Reynolds says.

At the high school level, the breakfast calories range is a minimum of 450 calories and a maximum of 600.

“At the high school, we had a breakfast pocket that was pretty popular,” Reynolds said. “That didn’t fit in anymore. We had to switch to smaller bagels, and we’re not selling as many as we used to.”

But overall the response from students has been positive.

“The kids are starting to get it,” Reynolds says. “Surprisingly, we got more negative response at the middle school level than at the high school. I think high school kids are somewhat conscious of wanting to eat healthy.”